Measuring quality of care in moderate and late preterm infants

Abstract

Objective To examine quality measures for moderate and late preterm (MLP) infants. Study Design By prospectively analyzing Vermont Oxford Network’s all NICU admissions database, we adapted Baby-MONITOR, a composite quality measure for extremely/very preterm infants, for MLP infants. We examined correlations between the adapted MLP quality measure (MLP-QM) in MLP infants and Baby-MONITOR in extremely and very preterm infants. Result We studied 376,219 MLP (30–36 weeks GA) and 57,595 extremely/very preterm (25–29 weeks GA) infants from 465 U.S. hospitals born from 2016 to 2020. MLP-QM summary scores in MLP infants had weak correlation with Baby-MONITOR scores in extremely and very preterm infants (r=0.47). There was weak correlation among survival (r=0.19), no pneumothorax (r=0.35), and no infection after 3 days (r=0.45), but strong correlation among human milk at discharge (r=0.79) and no hypothermia (r=0.76). Conclusion Modest correlation among hospital care measures in two preterm populations suggests need for MLP-specific care measures.

Neonatal subgaleal hemorrhage: twenty years of trends in incidence, associations, and outcomes

“…Additionally, inadvertent or unplanned hypothermia can be detrimental to NICU patients [31,32]. Fluid boluses and large-volume transfusions administered below physiological temperature can contribute to hypothermia.…”

“…With a desire to better understand these issues in our system, we undertook the present retrospective analysis. It includes all cases of neonatal SH recorded at all Intermountain Healthcare hospitals beginning with the end-date of the previous report (July 31,2010) through March 31, 2022. Our aims were to compare the following over the past two decades; 1) the annual incidence of recognized cases of neonatal SH, 2) known fetal/neonatal and obstetrical risk factors for SH, 3) the number of transfusions, and the speci c blood components administered, to each neonate recognized to have a SH, and 4) adverse outcomes (death or neurodevelopmental impairment) among these neonates when assessed at 24 ± 6 months-old.…”

Association Between Neonatal Intensive Care Unit Type and Quality of Care in Moderate and Late Preterm Infants

“…18,19 For MLP infants, the outcome was an MLP quality measure (MLP-QM) based on Baby-MONITOR and adapted to the MLP population. 20 Secondary outcomes were the individual components of the GA-specific quality measures. 20 The Baby-MONITOR measure consists of infant-level process measures (no admission hypothermia, no health care-associated infection, discharge on any human milk, antenatal steroid exposure, timely retinal examination), and outcome measures (survival to hospital discharge, no nonsurgically induced pneumothorax, no chronic lung disease, greater than median growth velocity).…”

“…20 Secondary outcomes were the individual components of the GA-specific quality measures. 20 The Baby-MONITOR measure consists of infant-level process measures (no admission hypothermia, no health care-associated infection, discharge on any human milk, antenatal steroid exposure, timely retinal examination), and outcome measures (survival to hospital discharge, no nonsurgically induced pneumothorax, no chronic lung disease, greater than median growth velocity). 19 The MLP-QM consists of infant-level process measures (no admission hypothermia, no health care-associated infection, discharge on any human milk) and outcome measures (survival to hospital discharge, no nonsurgically induced pneumothorax, no oxygen at 28 days of life or at discharge, change-in-weight z score, no extreme length of stay).…”

“…The development of Baby-MONITOR and the MLP-QM adaptation have been described in prior work. [19][20][21] Quality scores were calculated, adjusted, and standardized as previously described. [21][22][23][24] The Baby-MONITOR and MLP-QM scores were adjusted for relevant infant characteristics (GA, sex, 5-minute Apgar score, receipt of prenatal care,…”